Provider Demographics
NPI:1518285477
Name:PHARMACY HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:PHARMACY HEALTH SOLUTIONS LLC
Other - Org Name:GIANT GENIE PHARMACY HARRISBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-622-5060
Mailing Address - Street 1:PO BOX 2769
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-2769
Mailing Address - Country:US
Mailing Address - Phone:704-622-5060
Mailing Address - Fax:704-523-4347
Practice Address - Street 1:4310 PHYSICIANS BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7404
Practice Address - Country:US
Practice Address - Phone:704-454-5135
Practice Address - Fax:704-454-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NC105203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3419846OtherNCPDP PROVIDER IDENTIFICATION NUMBER